New Patient- Avian Name* First Last Birdss Name*Gender*MaleFemaleUnknownDNA tested?*YesNoAge/Date of Birth (if known)**EstimatedKnownColors*Bands or other identification, and numbers*Source of BirdWhere acquired*Pet StorePrivatepurchase/adoptionBreederOriginal source*Wild caughtDomestic bredUnknownDate acquired*Health HistoryTests Psittacosis Beak & Feather Polyomavirus No testing done Vaccines*Last vet visitWhereWhyHousing and Environment*CageAviaryFree in houseIndoorOutdoorWings trimmed?*YesNoDateWith the family or separate*Other birds and location in homeAny bird illnesses or deaths?*YesNoDo you smoke in the home?*YesNoCage bedding*Frequency and method of cage cleaning*How many hours of darkness does your bird experience each day?_*DietDescribe diet (seeds, pellets, fresh foods, amount, frequency etc)*How is water offered?*CupBottleAny recent changes to diet? Please describe*EmailThis field is for validation purposes and should be left unchanged.